scholarly journals Acute myocardial infarction with multiple mechanical complications

2016 ◽  
Vol 22 (1) ◽  
pp. 25-29
Author(s):  
Cristina Nedelcu ◽  
Victoria Ulmeanu ◽  
Liliana Tuta ◽  
Raluca Gheorghita ◽  
Mihaela Ilie ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Death Rate ◽  
Mechanical Complication ◽  
Mechanical Complications ◽  
High Death Rate ◽  
High Death ◽  
History Of ◽  
Immediate Surgery ◽  
Made In

Abstract The rupture of the inter-ventricular septum is a rare, but extremely severe mechanical complication of the acute myocardial infarction, which in most cases of no immediate surgery is fatal (30 days death rate – 80%). The incidence of the septum ventricular defect post-acute myocardial infarction was 1-3% in the period before crash injury therapy, dropping to 0.2% after introducing the thrombolytic treatment. The acute mitral failure and the septum ventricular defect are two mechanical complications of the acute myocardial infarction associated with high death rate, regardless of the progress made in medical and surgery therapeutic approach. This paper highlights the peculiarities of a clinical case like the acute myocardial infarction as the first manifestation of heart disease in a patient with no history of cardiovascular disease but with risk factors (obesity, dyslipidemia, hypertension), the ECG evident changes in the anterior territory and more discrete in the inferior territory, which established the initial diagnosis to be myocardial infarction and the presence of two mechanical threatening complications: ventricular septal flaw and acute mitral failure through posterior papillary muscle incomplete rupture.

Observations on the Life History of Laemophloeus minutus (Ol.) (Col. Cucujidae) when bred on various Stored Cereals and Cereal Products

1954 ◽  
Vol 45 (2) ◽  
pp. 341-350 ◽  
Author(s):  
Gwyneth C. Williams
Keyword(s):  
Life History ◽  
Adult Development ◽  
Death Rate ◽  
Fourth Instar ◽  
Cereal Products ◽  
High Death Rate ◽  
High Death ◽  
History Of ◽  
Newly Hatched Larvae ◽  
Maize Germ

Laemophloeus minutus (Ol.) has been reared on six food materials of a type with which the genus, Laemophloeus, is commonly associated in the field. Consideration of the length of egg to adult development, together with the mortality, recorded from each medium indicates that Manitoba wheat and whole-meal flour are equally favourable for the development of the species, followed in order of precedence by Plate maize, English wheat and, finally, National (85 per cent. extraction) and Canadian (70–75 per cent. extraction) flour which proved equally unfavourable.The stage of the life-history at which mortality mainly occurred varied with the diet. The high death-rate on English wheat was caused by the inability of newly hatched larvae to enter grains undamaged in the germ region. Mortality on National and Canadian flour occurred chiefly in the fourth instar.There were indications of cannibalism in both larval and adult stages, at any rate when the diet was unfavourable.The germ of wheat was attacked in preference to any other part of the grain. Maize germ was also consumed but whether it was preferred to the same extent as that of wheat was not established.Pupation was mainly, but not exclusively, intergranular in wheat. Normal cocoons were formed in National and Canadian flours but some larvae pupated in loose webbing or in flour free from webbing and freshly emerged adults were observed in unwebbed National and Canadian flour.

Twenty-eight Years' Lunacy Experience in Egypt (1895–1923)

1924 ◽  
Vol 70 (290) ◽  
pp. 380-410
Author(s):  
John Warnock
Keyword(s):  
Recovery Rate ◽  
Death Rate ◽  
Admission Rate ◽  
Hospital Treatment ◽  
Accident Rate ◽  
Unsuccessful Attempt ◽  
Blue Book ◽  
High Death Rate ◽  
High Death ◽  
Made In

This completes a résumé of the chief changes made in twenty-eight years. It was an unsuccessful attempt to manage a high admission-rate, no longer considerably helped by a high death-rate, in establishments not sufficient to deal with even a quarter of the admissions. Persistent overcrowding only palliated the excessive discharge of patients, and produced great difficulties in administration. The occupation of the dining rooms and corridors by beds prevented ordinary convenience. A high accident-rate and a low recovery-rate were inevitable results of the overcrowding. We were often forced to admit over a thousand cases a year, and to discharge as many, less the number of deaths. Meanwhile these discharged cases committed crimes, and we were continually incurring criticism for our actions. Whenever an extension of accommodation was granted, it was so small, and it took so long to provide, that on its completion it was swamped at once, and the overcrowding was but little relieved. Besides managing the Hospital, one had to besiege the authorities for funds for buildings, in season and out of season, and to take every opportunity to interest them in the work, and educate them as toits importance. The lack of beds for the insane in Egypt remains grave, while in England there are 8,663 vacancies (vide Blue Book for 1922). In twenty-eight years the number of beds for the insane in Egypt has risen from 300 to 1,841. Thus there are now 14 beds to every 100,000 of population. Compare 250 in England, and 3 in India to every 100,000. It is still seldom possible in Egypt to treat curable cases until their recovery; thus 527 uncured cases were discharged in 1922, and still only the dangerous and unmanageable can claim hospital treatment.

scholarly journals Ventricular Septal Rupture following Anterior Acute Myocardial Infarction: A Challenge to a Sub-District Physician

2021 ◽  
Vol 7 (1) ◽  
pp. 48-53
Author(s):  
Aditya Doni Pradana ◽  
Jarot Widodo
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Rare Complication ◽  
Hemodynamic Instability ◽  
Mechanical Complication ◽  
Ventricular Septal Rupture ◽  
Anterior Myocardial Infarction ◽  
Mortality And Morbidity ◽  
Mechanical Complications ◽  
Resource Setting

Background: Ventricular septal rupture (VSR) is one of the most serious mechanical complications following acute myocardial infarction (AMI). Although a rare complication, it is associated with significant mortality and morbidity. The purpose of this report was to present a case of VSR following anterior AMI in our hospital. Case Description: A 54-year old Javanese male presented persistent episode of breathlessness and lower limb swelling for the last two days with prior chest pain 7 days ago. Physical examination revealed a grade 3/6 holosystolic murmer loudest over the apex, S3 gallop, rales bibasally of the lung. Electrocardiographic evidence revealed for a recent anterior myocardial infarction. Chest X-Ray showed a cardiomegaly and pulmonary congestion. Transthoracic echocardiography revealed VSR at mid-anteroseptal with estimated length of 8-10 mm, preserved LVEF 51% with mid-apicoseptal akinesis. Multiple readmissions were noted for this patient in the follow-up with worsened conditions. Discussion: This is a challenging case report since our hospital is an incapable cath-lab sub-district hospital and far from PCI-capable center. It is critical that all patients with AMI have a brief evaluation for mechanical complications such as VSR. All patients who developed hemodynamic instability during AMI should be comprehensively examined for the murmur and any other heart sound that may provide valuable information. Conclusion: Every clinician especially in the low-resource setting should be aware of this potentially fatal mechanical complication as the mortality remains significantly high. Early prompt diagnosis and treatment is the key of achieving an optimal outcome.

scholarly journals P704 Mechanical complications of acute myocardial infarction in the era of early reperfusion therapy: a case report

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Proenca ◽  
R Alves Pinto ◽  
M Martins Carvalho ◽  
A Nunes ◽  
P M Araujo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricular ◽  
Mechanical Complication ◽  
Heart Team ◽  
Inferior Wall ◽  
Early Reperfusion ◽  
Mechanical Complications ◽  
Biventricular Function ◽  
Risk Of Rupture

Abstract Introduction Left ventricular pseudoaneurysm is a rare mechanical complication of myocardial infarction, and its incidence has decreased with the widespread use of reperfusion therapies. Pseudoaneurysm is the result of a free wall rupture contained by pericardial adherences and mural thrombi, which contain the bleeding and prevent cardiac tamponade. Clinical Presentation A 68-year-old woman who had hypertension, diabetes mellitus and chronic kidney disease (caused by diabetic nephropathy) was first admitted with acute myocardial infarction of the inferior wall. Emergent coronary angiography revealed proximal occlusion of the right coronary artery. Primary angioplasty was performed with three stents implantation. However due to transitory no reflow, verapamil, nitrate and intracoronary abciximab were administered with recovery of coronary flow. Patient remained stable, without recurrence of symptoms. Echocardiography, at discharge, showed normal biventricular function and no mechanical complications. Two months later, the patient was readmitted in the emergency room with constant chest pain, fatigue, prostration and loss of appetite beginning ten days earlier and an episode of syncope. Physical examination revealed fever, cardiac auscultation was rhythmic and without murmurs or pericardial friction rub, and pulmonary auscultation revealed crackles in inferior hemithorax. 12-lead electrocardiogram showed sinus rhythm, Q waves and negative T waves in inferior leads. Blood tests revealed leucocytosis, high sensibility troponin I was 28,8 ng/L and brain natriuretic peptide was 264,9 pg/mL. Chest-X-ray demonstrated enlargement of the cardiac silhouette and echocardiography showed moderate to large pericardial effusion with large amounts of fibrin close to right cardiac chambers and a basal inferior pseudoaneurysm with 23 mm x 24 mm; intracavitary contrast was administered without opacification of pericardial space; biventricular function remained normal. Patient was promptly admitted on Cardiac Intensive Care Unit with diagnosis of pseudoaneurysm due to myocardial infarction. Therapeutic with ticagrelor was suspended and surgical correction was proposed, after discussion in Heart Team. False aneurysm correction was performed with a bovine pericardial patch without complications, and the patient was discharged asymptomatic eight days later. Conclusion Even with lower incidence, pseudoaneurysms remains as a potential life-threatening due to its high risk of rupture. Prompt diagnosis, usually with echocardiography and surgical referral are crucial. Abstract P704 Figure. Inferior Pseudoaneurysm

scholarly journals Clinical Outcome of Ventricular Septal Rupture Complicating Acute Myocardial Infarction – A Single Centre Retrospective Study

2021 ◽  
pp. 197-203
Author(s):  
Jayanty Venkata Balasubramaniyan ◽  
Ravanasamudram Hariharan Lakshmi ◽  
Harsimran Singh ◽  
J. S. Sathyanarayana Murthy ◽  
Vaishnavi Chandrakumar
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Retrospective Study ◽  
Tertiary Care ◽  
Early Mortality ◽  
High Rate ◽  
Mechanical Complication ◽  
Ventricular Septal Rupture ◽  
Tertiary Care Centre ◽  
History Of

Objective: Ventricular Septal Rupture (VSR) following Acute Myocardial Infarction (AMI) is a fatal mechanical complication with high incidence of mortality. The aim of this study is to explore the clinical outcomes and to identify the factors related to early mortality in patients with VSR after AMI. Materials and Methods: This was a retrospective study and we collected clinical data of 21 adult patients with VSR following AMI from April 2012 and October 2020 who got admitted at our tertiary care centre. The patients were classified into two groups. The first group consisted of patients who died within two weeks from the diagnosis of VSR following AMI and the second group comprised of patients who survived more than two weeks after VSR. Results: A total of 21 patients (mean age of 66.19±9.47 years) were enrolled in this study. The most common MI was Anterior MI (71.4%) and the location of VSR was predominantly in the anterior and apical septum (76.2%). The overall early mortality was 85.9% (n=18). 80.95% (n=17) of patients died within two weeks of diagnosis of AMI. Of the 4 patients who survived more than two weeks, three patients survived. The operative mortality in our study was 47%. Conclusion: The prognosis for VSR in AMI remains poor. Renal failure is accompanied with high rate of early mortality in patients with VSR complicating AMI. History of smoking is associated with poor outcome.

scholarly journals 180-day readmission risk model for older adults with acute myocardial infarction: the SILVER-AMI study

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001442
Author(s):  
John A Dodson ◽  
Alexandra M Hajduk ◽  
Terrence E Murphy ◽  
Mary Geda ◽  
Harlan M Krumholz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Older Adults ◽  
Acute Myocardial Infarction ◽  
Risk Model ◽  
Functional Mobility ◽  
Derivation Cohort ◽  
History Of ◽  
Reported Health ◽  
Self Reported Health Status ◽  
Readmission Risk

ObjectiveTo develop a 180-day readmission risk model for older adults with acute myocardial infarction (AMI) that considered a broad range of clinical, demographic and age-related functional domains.MethodsWe used data from ComprehenSIVe Evaluation of Risk in Older Adults with AMI (SILVER-AMI), a prospective cohort study that enrolled participants aged ≥75 years with AMI from 94 US hospitals. Participants underwent an in-hospital assessment of functional impairments, including cognition, vision, hearing and mobility. Clinical variables previously shown to be associated with readmission risk were also evaluated. The outcome was 180-day readmission. From an initial list of 72 variables, we used backward selection and Bayesian model averaging to derive a risk model (N=2004) that was subsequently internally validated (N=1002).ResultsOf the 3006 SILVER-AMI participants discharged alive, mean age was 81.5 years, 44.4% were women and 10.5% were non-white. Within 180 days, 1222 participants (40.7%) were readmitted. The final risk model included 10 variables: history of chronic obstructive pulmonary disease, history of heart failure, initial heart rate, first diastolic blood pressure, ischaemic ECG changes, initial haemoglobin, ejection fraction, length of stay, self-reported health status and functional mobility. Model discrimination was moderate (0.68 derivation cohort, 0.65 validation cohort), with good calibration. The predicted readmission rate (derivation cohort) was 23.0% in the lowest quintile and 65.4% in the highest quintile.ConclusionsOver 40% of participants in our sample experienced hospital readmission within 180 days of AMI. Our final readmission risk model included a broad range of characteristics, including functional mobility and self-reported health status, neither of which have been previously considered in 180-day risk models.

scholarly journals Diagnostic markers for discriminating between acute aortic dissection and acute myocardial infarction during the pre-hospital phase: analysis of 3,195 cases

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Watanabe ◽  
H Yoshino ◽  
T Takahashi ◽  
M Usui ◽  
K Akutsu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Back Pain ◽  
Chest Pain ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Diagnostic Markers ◽  
Network Database ◽  
History Of ◽  
First Contact

Abstract   Both acute aortic dissection (AAD) and acute myocardial infarction (AMI) present with chest pain and are life-threatening diseases that require early diagnosis and treatment for better clinical outcome. However, two critical diseases in the very acute phase are sometimes difficult to differentiate, especially prior to arrival at the hospital for urgent diagnosis and selection of specific treatment. The aim of our study was to clarify the diagnostic markers acquired from the information gathered from medical history taking and physical examination for discriminating AAD from AMI by using data from the Tokyo Cardiovascular Care Unit (CCU) Network database. We examined the clinical features and laboratory data of patients with AAD and AMI who were admitted to the hospital in Tokyo between January 2013 and December 2015 by using the Tokyo CCU Network database. The Tokyo CCU Network consists of >60 hospitals that fulfil certain clinical criteria and receive patients from ambulance units coordinated by the Tokyo Fire Department. Of 15,061 patients diagnosed as having AAD and AMI, 3,195 with chest pain within 2 hours after symptom onset (537 AAD and 2,658 AMI) were examined. The patients with out-of-hospital cardiac arrest were excluded. We compared the clinical data of the patients with chest pain who were diagnosed as having AAD and AMI. The following indicators were more frequent or had higher values among those with AAD: female sex (38% vs. 20%, P<0.001), systolic blood pressures (SBPs) at the time of first contact by the emergency crew (142 mmHg vs. 127 mmHg), back pain in addition to chest pain (54% vs. 5%, P<0.001), history of hypertension (73% vs. 58%, P<0.001), SBP ≥150 mmHg (39% vs. 22%, P<0.001), back pain combined with SBP ≥150 mmHg (23% vs. 0.8%, P<0.001), and back pain with SBP <90 mmHg (4.5% vs. 0.1%, P<0.001). The following data were less frequently observed among those with AAD: diabetes mellitus (7% vs. 28%, P<0.001), dyslipidaemia (17% vs. 42%, P<0.001), and history of smoking (48% vs. 61%, P<0.001). The multivariate regression analysis suggested that back pain with SBP ≥150 mmHg (odds ratio [OR] 47; 95% confidence interval [CI] 28–77; P<0.001), back pain with SBP <90 mmHg (OR 68, 95% CI 16–297, P<0.001), and history of smoking (OR 0.49, 95% CI 0.38–0.63, P<0.001) were the independent markers of AAD. The sensitivity and specificity of back pain with SBPs of ≥150 mmHg and back pain with SBPs <90 mmHg for detecting AAD were 23% and 99%, and 4% and 99%, respectively. In patients with chest pain suspicious of AAD and AMI, “back pain accompanied by chest pain with SBP ≥150 mmHg” or “back pain accompanied by chest pain with SBP <90 mmH” is a reliable diagnostic marker of AAD with high specificity, although the sensitivity was low. The two SBP values with back pain are markers that may be useful for the ambulance crew at their first contact with patients with chest pain. Funding Acknowledgement Type of funding source: None

Levels of anxiety, depression and denial in patients with myocardial infarction

1997 ◽  
Vol 12 (3) ◽  
pp. 149-151 ◽  
Author(s):  
D Sarantidis ◽  
A Thomas ◽  
K Iphantis ◽  
N Katsaros ◽  
J Tripodianakis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Intensive Care Unit ◽  
Family History ◽  
Positive Family History ◽  
Anxiety And Depression ◽  
Previous Myocardial Infarction ◽  
History Of ◽  
Seeking Help ◽  
Anxiety Depression

SummaryIn this study we investigated 1) the changes in anxiety, depression and denial from admission to discharge in patients admitted to the intensive care unit following an acute myocardial infarction and 2) the effect of smoking habits, time lapsed from the appearance of symptoms to seeking help behavior, presence of a person that motivated the patient to seek help, previous myocardial infarction (MI) and family history of MI, on these changes. The results indicated that 1) the levels of both anxiety and depression increased from admission to discharge, while denial decreased; 2) positive family history of MI was associated with lower difference of denial between admission and discharge.

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